| NPI | 1588934251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 277327) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD18723) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 50779) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2022-10-04 |