| NPI | 1245072289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 80350) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-13233) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-07-30 |