| NPI | 1295761062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0432100) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2004001456) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2007-09-11 |