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 |