| NPI | 1679545537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 88962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 88962) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AL 31798) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2022-10-13 |