| NPI | 1134481047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME DO2594) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS20698) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NH 18858) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2024-02-05 |