| NPI | 1538457684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 265681) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 073846) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2021-05-25 |