| NPI | 1982897955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101251207) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2009-01404) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2022-08-11 |