| NPI | 1629231477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME112183) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 232951) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2012-06-22 |