| NPI | 1225760036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2023018490) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022023918) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2026-05-04 |