| NPI | 1720240955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 49512) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 2547) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2025-04-18 |