| NPI | 1730316555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD045878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-240151) |
| 207R00000X Internal Medicine (Licence: TN MD54022) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN MD54022) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2023-01-26 |