| NPI | 1952422578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD29190) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT185754) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2009-06-16 |