| NPI | 1164836987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S2578) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 94-08473) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301114958) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-10-16 |