| NPI | 1497742944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS 8645) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 069478) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2018-01355) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2022-06-24 |