| NPI | 1912901752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IN 091290A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 27076) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2018-10-01 |