| NPI | 1306891296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 100758) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AR C-7554) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-09-30 |