| NPI | 1548240104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ND 231) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 2625) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2019-10-29 |