| NPI | 1932153913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO R9N55) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AR R3879) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 0000032129) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 18119) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2015-08-21 |