| NPI | 1164089058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS023243) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102207354) |
| Enumeration Date | 2019-05-26 |
| Last Update Date | 2023-10-10 |