| NPI | 1770720823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7471621-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD17304) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2024-01-09 |