| NPI | 1245440510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 46362) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO 46362) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 510105436) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 510105436) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-12-09 |