| NPI | 1548825524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 69616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 261208) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-07-12 |