| NPI | 1073653663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 40667) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 01059429A) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2013-06-19 |