| NPI | 1275687865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2017-02037) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 49805) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-10-04 |