| NPI | 1003926270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.20968) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: AL MD.20968) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-10-06 |