| NPI | 1508953241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 101203) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-24580) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2012-06-08 |