| NPI | 1114154192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 65912-20) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301096795) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2018-06-25 |