| NPI | 1316147846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2009-00953) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 84295) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD437862) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2019-12-13 |