| NPI | 1518143460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01636) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2011-01636) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2017-04-26 |