| NPI | 1114901444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 12082) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MI AI070134) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 6727480001) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2019-10-31 |