| NPI | 1083875462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 261383) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 16841) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2024-11-12 |