| NPI | 1861665952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D75705) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD445085) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2013-09-16 |