| NPI | 1659507721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101249182) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2014-00932) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2021-10-13 |