| NPI | 1003818766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101014375) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 02002655A) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2016-10-20 |