| NPI | 1306410642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 71931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA Mt222970) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2022-07-12 |