| NPI | 1972032803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 62512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76151) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-04-28 |