| NPI | 1023165081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: ME 1117) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME 1117) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2008-09-26 |