| NPI | 1942281662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 035770) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD14994) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2019-11-08 |