| NPI | 1871543405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX M7072) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD428492) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-10-28 |