| NPI | 1336589035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301512337) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 10801) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-12-17 |