| NPI | 1992232847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2021-01201) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009080) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 87617) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2024-04-15 |