| NPI | 1174614390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: SC 84390) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: VT 42-0010625) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-10-23 |