| NPI | 1972669679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MO60265170) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9300475) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2012-11-27 |