| NPI | 1346249315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME148755) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 14305) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO 37261) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 26359) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-03-24 |