| NPI | 1942569488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD461784) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D81302) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2022-07-21 |