| NPI | 1295866713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: OK 29520) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 6399) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: KS 04-36873) | |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: MO 2008014964) | |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: IA 38991) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-09-02 |