| NPI | 1679754188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0074865) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101249265) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2023-10-24 |