| NPI | 1114457645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD481080) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2725) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2023-08-24 |