| NPI | 1740418094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 54483) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 295977) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-05-07 |