| NPI | 1316393291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 89147) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 83756) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 218353) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-01-12 |