| NPI | 1528595378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301504953) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351032744) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-08-14 |