| NPI | 1932514700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 82739) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 89680) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-06-05 |