| NPI | 1174502207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4375) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 47184) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS 9787) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 05395) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2010-01-13 |