| NPI | 1588984702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018893) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 2005984) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2021-08-23 |