| NPI | 1912019415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: MN 27937) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine (Licence: ND 5919) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-05-17 |