| NPI | 1255759346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0116027906) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101259834) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2020-06-22 |