| NPI | 1508434671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2022023951) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12213) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-01-09 |