| NPI | 1457685919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: UT 9003692-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9003692-1205) |
| 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: MI 4301094767) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2021-12-03 |