| NPI | 1881255941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX U1898) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5151013735) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-06-13 |