| NPI | 1649830126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2024016774) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 8554) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-08-06 |