| NPI | 1104994375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2006022624) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AZ 37888) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 37888) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-08-06 |