| NPI | 1285621599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 81841) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 7008) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2007-07-09 |