| NPI | 1669486692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MS 18004) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM A-1167-01) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-07-19 |