| NPI | 1831178102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136877) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 165540-8905) |
| 207R00000X Internal Medicine (Licence: NC 9400828) | |
| 207R00000X Internal Medicine (Licence: NM MD2017-0722) | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: NC 9400828) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-03-07 |