| NPI | 1023372380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD480218) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2015041559) |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2023-10-12 |