| NPI | 1366753600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 245309) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 245309) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2015-09-01 |