| NPI | 1538727391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351044761) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5315206750) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2024-05-09 |