| NPI | 1689298564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 83348-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11855) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-07-09 |