| NPI | 1053759282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV DO2192) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0953) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV SL0953) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2019-10-29 |