| NPI | 1073243861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 84597-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL18677) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2026-07-30 |