| NPI | 1215908876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ND 1022) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 5808) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2019-10-29 |