| NPI | 1043673213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D89024) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D89024) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-08-20 |