| NPI | 1093796955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 6855) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 51049) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 48219) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2017-03-03 |