| NPI | 1255363602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA a061211) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: HI 13084) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-09-19 |