| NPI | 1285741553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 44315) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 115444) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2015-05-12 |