| NPI | 1922577006 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 1705) | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 094038) | 
| Enumeration Date | 2018-11-18 | 
| Last Update Date | 2018-11-18 |