| NPI | 1285605063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 041896) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME119141) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-07-07 |