| NPI | 1639294259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ND 14574) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 52167) |
| 208100000X Physical Medicine & Rehabilitation (Licence: ND PT14574) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-03-26 |