| NPI | 1376048793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11441510-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-16721) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-08-31 |