| NPI | 1912009523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 57133) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 104830) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2023-09-02 |