| NPI | 1669448585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO R5F04) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0421408) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2007-11-01 |