| NPI | 1184870255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 51158) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 56002) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2023-01-12 |