| NPI | 1003849977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD420989) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9800485) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-05-04 |