| NPI | 1518074624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 45027) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2003014015) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-08-07 |