| NPI | 1720245871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX p1729) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML60095617) |
| 207R00000X Internal Medicine (Licence: TX BP10032001) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2026-08-20 |