| NPI | 1942837455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX V0720) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS19350) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-05-16 |