| NPI | 1104207091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-42408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08628) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2023-04-24 |