| NPI | 1134113335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101051306) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9501014) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2024-02-22 |