| NPI | 1003109596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 292192) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DE C2-0011274) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101023802) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2022-08-02 |