| NPI | 1881032746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 67054) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 58407) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2021-05-19 |