| NPI | 1437389301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 8687701-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194532) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 53356) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 105013) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2020-04-28 |