| NPI | 1962596791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 27061) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 49518-020) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-09-20 |