| NPI | 1023505849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 75201) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101027032) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2024-02-21 |