| NPI | 1619531878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME161917) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351044207) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2023-10-11 |