| NPI | 1972669349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E7345) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX E7345) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2024-11-06 |