| NPI | 1568476190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101260269) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC MMD.33098) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-09-23 |