| NPI | 1134218100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 23638) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 15701) |
| 204R00000X Electrodiagnostic Medicine (Licence: TN 15701) | |
| 202C00000X Independent Medical Examiner (Licence: TN 15701) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-09-28 |