| NPI | 1801535513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 81586-21) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 100216-851) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-07-24 |