| NPI | 1780704593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301088725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088725) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-02-17 |