| NPI | 1831166867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 37035) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 37035) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-03-18 |