| NPI | 1487674784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA DO-05280) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 069635) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD H66361) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-12-11 |