| NPI | 1093241911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 89269) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.41831) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-03-30 |