| NPI | 1992933147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101258601) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC LL31864) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2015-08-18 |