| NPI | 1093004061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP661) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME138733) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2018-12-18 |