| NPI | 1609226810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME144592) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 271225) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IA R-10666) | |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2020-07-21 |