| NPI | 1205829314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 22162) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 022162) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2018-12-13 |