| NPI | 1013917459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 21661) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 69204) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-06-17 |