| NPI | 1205940467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-38402) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 20027) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2019-09-06 |