| NPI | 1659306660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD-026827-L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD-026827-L) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-11-15 |