| NPI | 1134136492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 310000) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC MD18859) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-07-10 |