| NPI | 1023457371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60982673) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301103168) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD D84223) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2019-11-07 |