| NPI | 1639101744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 0076009) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A055004) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-06-20 |