| NPI | 1285155176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MS 6603) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 11381) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |