| NPI | 1043650427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101254351) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 271696) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA BC60500936) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2015-02-18 |