| NPI | 1275890956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017031975) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-40391) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-03-23 |