| NPI | 1053351247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301063353) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: MI JS063353) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301063353) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2014-11-12 |