| NPI | 1043536865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 262968) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 61907-21) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2020-05-29 |