| NPI | 1821017385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64960) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL me107218) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 67602-20) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: SD 8633) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-03-19 |