| NPI | 1396122370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-06305) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 85067) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2024-02-19 |