| NPI | 1013175538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS10707) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 5076) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2011-12-12 |