| NPI | 1144260332 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301055962) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: MI EA055962) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301055962) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-11-12 |