| NPI | 1144646613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: UT 142983349-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2184) |
| Enumeration Date | 2014-03-08 |
| Last Update Date | 2026-08-04 |