| NPI | 1659659282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 65587) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301098870) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2023-06-07 |