| NPI | 1568993699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101274443) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 86645) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2022-10-27 |