| NPI | 1669811659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS018604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116026164) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2022-07-21 |