| NPI | 1225239148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 52882) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101017183) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2017-02-14 |