| NPI | 1316922875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SD 8271766) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA MD-33553) |
| 207R00000X Internal Medicine (Licence: IA MD-33553) | |
| 207R00000X Internal Medicine (Licence: SD 14467) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2026-08-31 |