| NPI | 1255695136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD456524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125061518) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2019-02-28 |