| NPI | 1972524213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CT 60362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 60362) |
| 225100000X Physical Therapist (Licence: CT 007172) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-10-19 |