| NPI | 1568641769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 29519) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.014013) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2019-12-02 |