| NPI | 1205210739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2017-0931) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2017-0931) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2023-11-29 |