| NPI | 1578856779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MT MED-PHYS-LIC-90237) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q4100) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2021-02-03 |