| NPI | 1114149903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2007032281) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2007032281) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-03-19 |