| NPI | 1477810885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 192126) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 60417) |
| 208D00000X General Practice (Licence: MN 60417) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-12-28 |