| NPI | 1124269824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 113242) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL TRN12682) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2012-07-10 |