| NPI | 1194219493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD485807) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD485807) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-09-03 |