| NPI | 1609336569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 76990) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 11899053-1205) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-08-21 |