| NPI | 1477952190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102205319) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102205319) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2022-09-22 |