| NPI | 1851347587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 14611) |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit (Licence: SC 14611) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-06-12 |