| NPI | 1336408947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0075809) |
| Additional Taxonomies | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: FL 15525) |
| 208600000X Surgery (Licence: PA OS019371) | |
| 208600000X Surgery (Licence: VA 0102205761) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2020-06-16 |