NPI | 1598387185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X (Licence: MN 69505) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11788) |
208100000X Physical Medicine & Rehabilitation (Licence: MN 69505) | |
Enumeration Date | 2020-05-18 |
Last Update Date | 2024-06-19 |