| NPI | 1043599327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 63415) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ND 13783) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2023-12-14 |