| NPI | 1639128408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 48756) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301093647) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MT188491) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD432290) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2020-05-22 |