| NPI | 1134899032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: HI PT4287) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 60709) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA pt60508306) | |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2021-09-14 |