| NPI | 1871600148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2008-02092) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 44811) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-02-17 |