| NPI | 1346269669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME90603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G20885) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME90603) | |
| 208D00000X General Practice (Licence: CA G20885) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-11-29 |