| NPI | 1457468993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD24542) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G84332) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |