| NPI | 1568501989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS011936) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS011936) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |