| NPI | 1992700413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J2508) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J2508) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2012-09-25 |