| NPI | 1538692967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2021-00717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 227662) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2021-07-20 |