| NPI | 1659457794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 25404) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 25404) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-07-26 |