| NPI | 1457748261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 208100000X) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 208D00000X) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2019-08-07 |