| NPI | 1326664343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD481886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220418) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2025-08-05 |