| NPI | 1164956413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64184) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 28981) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-09-15 |