| NPI | 1922045087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 31984) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX H6592) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2007-07-08 |