| NPI | 1376577635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD50027) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 96981) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-03-21 |