| NPI | 1285824037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 68016) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 247899) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AL 28616) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2018-01-30 |