| NPI | 1316174642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101254420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P24010) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2025-05-13 |