| NPI | 1568164184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351053816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.084133) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2025-07-10 |