| NPI | 1285697524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME41743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME41743) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2020-06-10 |