| NPI | 1932281821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301051649) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301051649) |
| 207R00000X Internal Medicine (Licence: MI 4301051649) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-10-15 |