| NPI | 1598387185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MN 69505) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 69505) |
| 207R00000X Internal Medicine (Licence: IA R11788) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2025-07-24 |