| NPI | 1376038109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP61238655) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2019020878) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-06-23 |