| NPI | 1316928377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 24065) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2005-01611) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-10-08 |