| NPI | 1093871774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD439737) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT188126) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2011-07-06 |