| NPI | 1275645814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 52757) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 55400-20) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-08-15 |