| NPI | 1780682963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301074605) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD422257) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2016-12-07 |