| NPI | 1467814483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021035552) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 3924) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-09-09 |