| NPI | 1568778371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D79294) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2014-01086) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2017-02-16 |