| NPI | 1780034991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 60665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125068252) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017027309) | |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2025-11-04 |