| NPI | 1386922193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 106401) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248849) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2012-11-19 |