| NPI | 1881910255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 17082) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 62622-20) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 269666) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60298555) | |
| Enumeration Date | 2010-04-10 |
| Last Update Date | 2018-04-26 |