| NPI | 1962991133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD208888) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 280959) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-02-10 |