| NPI | 1104280007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC DO90042) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 2584) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2023-09-28 |