| NPI | 1952628802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD206191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q9881) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 206191) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2022-07-19 |