| NPI | 1104276369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 59772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211234) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-10-08 |