| NPI | 1972565257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 022576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 022576) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 022576) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-01-30 |