| NPI | 1245429018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 6351860-1205) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: UT 6351860-1205) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2021-11-02 |