| NPI | 1295222420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DC MD210001827) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101273867) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-11-09 |