| NPI | 1104020858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD434828) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT184793) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-03-07 |