| NPI | 1457353716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 42025) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 44539) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 61853) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-11-12 |