| NPI | 1851350151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD.024894) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 024894) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.024894) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-07-07 |