| NPI | 1578677084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 55750) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CO 30858) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2012-04-24 |