| NPI | 1861519050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 12346) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 12346) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2021-12-09 |