| NPI | 1376715664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 30211) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301095138) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2020-09-23 |