| NPI | 1043202203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME113742) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-109303) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2012-08-22 |