| NPI | 1538115431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3420) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX M3420) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2014-12-26 |