| NPI | 1699207407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD477645) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT213694) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-08-30 |