| NPI | 1376857060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1316453) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 36927) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2020-07-08 |