| NPI | 1235360769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 006081) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0674) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 006081) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2019-03-12 |