| NPI | 1518457738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NH 22354) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD28041) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2025-03-26 |