| NPI | 1316500788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.47946) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME151993) |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2024-06-11 |