| NPI | 1093770794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 023512) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 023512) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2013-09-03 |