| NPI | 1346463668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101246326) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 045343) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2022-07-21 |