| NPI | 1225129141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 8608) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 8608) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-10-21 |