| NPI | 1629464433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-43428) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020027222) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-09-30 |