| NPI | 1003949751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101245376) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT188926) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2011-05-11 |