| NPI | 1740416965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009022188) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009012806) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2016-05-16 |