| NPI | 1558594069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P7540) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10038060) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2021-01-05 |