| NPI | 1235578931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 080036) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2017-00635) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-10-10 |