| NPI | 1801871298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 55178) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 30126) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2019-05-23 |