| NPI | 1811302771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS14304) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL UO4285) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2018-06-26 |