| NPI | 1407866528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 00025358) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 48767) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2016-07-21 |