| 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 |