| NPI | 1972568541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 5935) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 5935) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2022-10-04 |