| NPI | 1821135930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D41114) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D41114) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-06-12 |