| NPI | 1225491004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2022008983) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 41415) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-09-20 |