| NPI | 1902832785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 20823) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 20823) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2017-09-27 |