| NPI | 1801196639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD449285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE CI-0025047) |
| 207R00000X Internal Medicine (Licence: PA MD449285) | |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2026-03-30 |