| NPI | 1871790394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 077574) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD445764) |
| 207R00000X Internal Medicine (Licence: FL TRN11514) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2019-01-15 |