| NPI | 1588627970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1129) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV 1129) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2023-09-13 |