| NPI | 1457577652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 249755) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101017050) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2014-06-25 |