| NPI | 1497754691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 39090) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-25037) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2010-11-09 |