| NPI | 1265724678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2014008383) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2010017670) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2014-06-24 |