| NPI | 1417950213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M6464) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: ID M6464) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2018-08-13 |