| NPI | 1962464099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD169575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2006-01839) |
| 207R00000X Internal Medicine (Licence: SC 23671) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2006-01839) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 23671) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2018-03-17 |