| NPI | 1750762175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD322462) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT 209439) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN MD59885) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-01-03 |