| NPI | 1366445991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME122131) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A60531) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2014-0144) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2015-01-14 |