| NPI | 1730699232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5151016070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018453) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2026-02-07 |