| NPI | 1407848880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 35732) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-37629) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2025-07-24 |