| NPI | 1093733792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL LL855) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD-018774) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-12-02 |