| NPI | 1639138969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO DO107023) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 2353) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-09-02 |