| NPI | 1255817086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 329273) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2019018915) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2022-08-22 |