| NPI | 1306036975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 43896) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP216) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT190022) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2021-12-15 |