| NPI | 1740624451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME135242) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.35559) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2018-08-31 |