| NPI | 1780095752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301105287) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI L241021) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2024-01-31 |