| NPI | 1023075272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 106257) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-25099) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2011-02-09 |