| NPI | 1376988535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2021-0789) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A155700) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2023-08-16 |