NPI | 1649864372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX V7887) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15999-i) |
2083X0100X Preventive Medicine, Occupational Medicine (Licence: GA 87932) | |
208D00000X General Practice (Licence: GA 87932) | |
Enumeration Date | 2021-02-23 |
Last Update Date | 2025-05-07 |