| NPI | 1417154626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N8864) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11559) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2019-07-01 |