| NPI | 1295395556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 00116034234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT219227) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-10-04 |