| NPI | 1154403616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N6896) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML20008749) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2011-02-25 |