| NPI | 1598797250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME150580) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2002019268) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-07-08 |