| NPI | 1528267150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 55414) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 55549) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2015-01-13 |