| NPI | 1215164744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 252253) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 16148) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2023-03-27 |