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 |