| NPI | 1639313778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2013018541) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-38305) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2015-09-02 |