| NPI | 1902127145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0089602) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME129815) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-02-04 |