| NPI | 1760462014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD028536L) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: PA MD028536L) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2008-01-16 |