| NPI | 1144420894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102202745) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA L231462) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2011-01-13 |