| NPI | 1104869007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200101611) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0047271) |
| 208100000X Physical Medicine & Rehabilitation (Licence: DE C1-0004187) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-09-09 |