| NPI | 1104261874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60788009) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 5499181-1205) |
| 207R00000X Internal Medicine (Licence: AZ R73802) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-02-03 |