| 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 |