| NPI | 1912991159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NH 8900) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: NH 8900) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-04-13 |