| NPI | 1427283613 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13928)  | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OT013134)  | 
| 208VP0000X  (Licence: FL OS13928)  | |
| Enumeration Date | 2009-05-18 | 
| Last Update Date | 2023-02-10 |