| NPI | 1659932895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301509163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351045597) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-03-06 |