| NPI | 1881799989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2009-0071) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2009-0071) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2023-11-07 |