| NPI | 1093197188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101272249) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R4130) |
| 208600000X Surgery (Licence: SC 1232284) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2024-06-14 |