| NPI | 1083742563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301081925) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301081925) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2019-06-24 |