| NPI | 1649652116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301502416) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 263860) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2021-03-31 |