| NPI | 1659371557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX L7175) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AR C7750) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-14 |