| NPI | 1649205980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 7995) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 1221) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-11-08 |