| NPI | 1194574178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 80318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34233) |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2025-09-02 |