| NPI | 1679543979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 33049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33469) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 33049) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2009-03-11 |