| NPI | 1356333496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO MDR4208) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0413279) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-07-08 |