| NPI | 1063653798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 50855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017995) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 53709-021) | |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2022-03-01 |