| NPI | 1285608752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 335350) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 88900) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY 31321) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2023-10-30 |