| NPI | 1366820383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 007807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 007807) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2026-02-23 |