| NPI | 1710905559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A44116) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX H6810) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA MD040093L) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA050288) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 174948-1) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NM 84189) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-02-15 |