| NPI | 1073926861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301115288) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-064877) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-02-25 |