| NPI | 1003888504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD443844) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0031884) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-02-21 |