| NPI | 1417332909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS17377) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 82479) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2021-02-03 |