| NPI | 1346553815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018701) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MI 5101018701) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2015-01-07 |