| NPI | 1295708584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 00018155) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME120607) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2023-11-13 |