| NPI | 1407090236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 50388) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 50388) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2026-06-01 |