| NPI | 1134888183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2026022108) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025020175) |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2026-06-29 |