| NPI | 1376525246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 43614) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 43614) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2014-02-05 |