| NPI | 1477174548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT219786) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101285964) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2025-09-09 |