| NPI | 1225320450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 21954-20) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 21954) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-05-05 |