| NPI | 1609439611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO.3203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7352) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2023-05-25 |