| NPI | 1710204904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX 07950390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 07950390) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX 07950390) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX 07950390) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2010-04-27 |