| NPI | 1912186651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 29421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29421) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2026-03-13 |