| NPI | 1184135121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MA060498) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6916) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2019-05-14 |