| NPI | 1023159027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 7249) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 7249) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2015-07-30 |