| NPI | 1235355900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 50153) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101249980) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2023-05-25 |