| NPI | 1649589896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR DO166659) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 81533101204) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2014-06-24 |