| NPI | 1033237524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME153906) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD433440) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-07-09 |