| NPI | 1871545244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301099843) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 38999) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-08-03 |