| NPI | 1275667230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD17881) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT186224) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2012-03-06 |