| NPI | 1598021479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2016023767) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-39027) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2017-11-08 |