| NPI | 1255354262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101016339) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 1833) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-05-31 |