| NPI | 1407949050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI MD12200) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: HI MD12200) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-09-16 |