| NPI | 1659440907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 10780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10785) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-01-11 |