| NPI | 1679859532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME127044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME127044) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2026-01-28 |