| NPI | 1144665894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV DO3383) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1303) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2023-06-30 |