| NPI | 1336103365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9900850) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9900850) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-12-07 |