| NPI | 1386755254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2001011435) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-27786) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-01-05 |