| NPI | 1033554597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2023-00295) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS15370) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-06-28 |