| NPI | 1134150527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 25623) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 6065319-1205) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2011-10-12 |