| NPI | 1962495531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 27306) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 41890) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2022-05-27 |