| NPI | 1548261282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 22839) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 22839) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2014-02-10 |