| NPI | 1518051192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 36997) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200401683) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2009-05-28 |