| NPI | 1548754344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 39479) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2019019197) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-07-12 |