| NPI | 1669670501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2012018718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9406867) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 51112) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-35006) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2023-10-17 |