| NPI | 1225110448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 238467) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML20008747) |
| 208100000X Physical Medicine & Rehabilitation (Licence: RI MD17504) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2022-11-09 |