| NPI | 1063462992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-24433) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 102443) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-08-23 |