| NPI | 1659302123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD054264L) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: PA MD054264L) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-09-29 |