| NPI | 1457358590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME61639) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME61639) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2020-10-12 |