| NPI | 1942658240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021017867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-08904) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2021-07-29 |