| NPI | 1154760502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV DO2590) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MT 67408) |
| 208M00000X Hospitalist (Licence: OR PG162823) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2020-11-30 |