| NPI | 1164859484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D89128) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D89128) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2022-07-21 |