| NPI | 1245891225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 81097) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 8588) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2023-08-14 |