| NPI | 1588239776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101028541) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5151015127) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-07-02 |