| NPI | 1063524163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 005311) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM A131505) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-11-13 |