| NPI | 1558713115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 68891) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11543056-1204) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2021-07-01 |