| NPI | 1013397520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 007854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066483) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2019-12-11 |