| NPI | 1336302546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 8836132-1204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018512) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-11-27 |