| NPI | 1629285549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 064559) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 57011021) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX Q0065) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2017-05-25 |