| NPI | 1760973812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME154446) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.07182) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-04-10 |