| NPI | 1497100820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: FL OS21559) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS022094) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-12-30 |