| NPI | 1942262399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: AZ 2543) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 2543) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2023-02-02 |