| NPI | 1407207483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 69527) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020017643) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2021-08-02 |