| NPI | 1992796163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P7017) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 23284) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2013-07-23 |