| NPI | 1033401765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2021-02050) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS016932) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2021-09-08 |