| NPI | 1326332230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 270928) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301108549) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 124482) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-07-21 |