| NPI | 1639105307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2013-02339) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2013-02339) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NC 2013-02339) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2023-12-18 |