| NPI | 1407350895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD479409) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD479409) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-01-07 |