| NPI | 1821049909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD444452) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 45568) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2011-12-02 |