| NPI | 1912090127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 42285) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 59130) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-03-29 |