| NPI | 1790714368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 063881) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL 25816) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-03-17 |