| NPI | 1790421394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351054880) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.083483) |
| Enumeration Date | 2022-05-07 |
| Last Update Date | 2025-06-18 |