| NPI | 1104352921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 338781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 85924) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 338781) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-10-03 |