| NPI | 1780666404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 28026) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD153557) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2020-02-24 |