| NPI | 1992702831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-30495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 30495) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-02-05 |