| NPI | 1922027044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY TP096) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 056729) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-10-10 |