| NPI | 1609372648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-47341) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020032469) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-07-25 |