| NPI | 1609840891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 46150) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 6057) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-08-21 |