| NPI | 1003895178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 15157) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 31601) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2012-04-17 |