| NPI | 1477546224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 52974) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 6895) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2020-03-04 |