| NPI | 1629574173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D97011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D97011) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2026-08-12 |