| NPI | 1205859535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-14009) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 83180) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-01-25 |