| NPI | 1073594230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 83038) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM 2002-0482) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-12-22 |