| NPI | 1932374824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NH 14648) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 226318) |
| 208100000X Physical Medicine & Rehabilitation (Licence: ME DO3159) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2023-11-20 |