| NPI | 1548442262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 17463) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17463) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2018-05-30 |