| NPI | 1285745554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 54748-20) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0066662) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-04-30 |