| NPI | 1750351003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME141440) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD053377L) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-01-14 |