| NPI | 1861060592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2022024327) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021022533) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-06-30 |