| NPI | 1265689095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME162021) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 16059) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2023-07-11 |