| NPI | 1649371709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A45586) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A45586) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2010-06-11 |