| NPI | 1215021696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD2004-0760) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM MD20040760) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-11-27 |