| NPI | 1669932752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 81582-21) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125074242) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-07-17 |