| NPI | 1831236108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 50192) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA 60028014) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-06-11 |