| NPI | 1992169759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SD 12085) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 62706) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-09-30 |