| NPI | 1255378741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: MI 4301063401) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301063401) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-01-12 |