| NPI | 1962843680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 075653) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 075653) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2020-06-10 |