| NPI | 1306970595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME109777) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301087819) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2022-05-31 |