| NPI | 1689780009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 26921) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 01041323) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2016-07-08 |