| NPI | 1316282346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 3086) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO3400) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2020-01-21 |