| NPI | 1003807538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101251254) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 80380) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2023-10-06 |