| NPI | 1508354572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 5171) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102207775) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2023-12-06 |