| NPI | 1811960230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 40156) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 47842) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 37043) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2012-06-27 |