| NPI | 1740230358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 037809) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 037809) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-08-06 |