| NPI | 1962592600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 045347) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 045347) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-05-05 |