| NPI | 1942240817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301085039) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2018-0791) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-02-22 |