| NPI | 1316189590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101256134) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101256134) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2023-02-06 |