| NPI | 1386054997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101024378) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 299540) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-04-07 |