| NPI | 1952374043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME110649) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME110649) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-08-28 |