| NPI | 1356879092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101275750) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D94668) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2022-10-11 |