| NPI | 1962450213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S3567) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 35103) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX S3567) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-12-27 |