| NPI | 1780111807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS19302) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 2427) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2022-11-25 |