| NPI | 1902919723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 37278) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 32249-20) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-11-20 |