| NPI | 1861771107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 348) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 517) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |