| NPI | 1649296690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 27788) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200600352) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-06-07 |