| NPI | 1871908582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301508001) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301105222) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-10-20 |