| NPI | 1376571950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 26055) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 26055) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2012-10-25 |