| NPI | 1447570007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 053679) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MT197711) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2021-11-11 |