| NPI | 1336146703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ND 5962) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX H9633) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2012-01-18 |