| NPI | 1699065771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WV 28503) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0081409) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2022-04-07 |