| NPI | 1770713661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0054222) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OL60093327) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 006073) | |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2015-02-18 |