| NPI | 1356799159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301502189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301109939) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301109939) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2020-06-15 |