| NPI | 1043236284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101254569) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2004021469) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-01-04 |