| NPI | 1174977219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-05-03 |