| NPI | 1841264900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301082427) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 47146) |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 059351) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2016-10-20 |