| NPI | 1154445427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 052938) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101241310) |
| 208VP0000X (Licence: VA 0101241310) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-06-24 |