| NPI | 1851316830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 10462) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 67043) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-07-27 |