| NPI | 1760646392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 27258) |
| Additional Taxonomies | 202K00000X (Licence: OK 27258) |
| Enumeration Date | 2008-07-13 |
| Last Update Date | 2023-03-14 |