| NPI | 1336308345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 26655) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 104457) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 52311) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2012-07-17 |