| NPI | 1285756486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-03976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 3976) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101016420) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2018-03-28 |