| NPI | 1194068437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID O-1521) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 007103) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2021-06-17 |