| NPI | 1417337387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID O-1242) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ND RL13716) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-09-19 |