| NPI | 1073642880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 00019762) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 025873) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY 39752) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2016-04-25 |