| NPI | 1992841167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 049958) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1855) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 232915) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2015-11-09 |