| NPI | 1477658326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J9179) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J9179) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-11-15 |