| NPI | 1215027362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102203302) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO-899) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-05-12 |