| NPI | 1558781120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 290305) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 63446) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2021-11-09 |