| NPI | 1063040533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 89921) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 89921) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-08-28 |