| NPI | 1043331903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX M4300) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX M4300) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2013-06-05 |