| NPI | 1104441013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102208220) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021019753) |
| 207R00000X Internal Medicine (Licence: MO 2020016721) | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2024-06-21 |