| NPI | 1215420237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2018019780) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 11-05876) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |