| NPI | 1780693598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DC MD17907) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101045270) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-10-03 |