| NPI | 1407888936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 226587) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 226587) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-07-23 |