| NPI | 1093752883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 23401) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 47338-20) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-01-11 |