| NPI | 1417915596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 00023044) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 311032) |
| 207RB0002X Internal Medicine, Bariatric Medicine (Licence: IN 01094928A) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2026-04-09 |