| NPI | 1104809664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS002681L) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB23292000) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA KO000034L) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS2470) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2010-07-27 |