| NPI | 1821055203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 060159) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 79484) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2014-12-04 |