| NPI | 1144475146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME00000pending) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 3565091205) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2018-12-07 |