| NPI | 1285024737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2022-1084) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT214505) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2023-07-13 |