| NPI | 1235441049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 28668) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD-42832) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD452117) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2020-12-28 |