| NPI | 1922298801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 57575) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 4088) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2014-03-25 |