| NPI | 1316114135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 0052774) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35096247) |
| 208100000X Physical Medicine & Rehabilitation (Licence: ID M11581) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60268993) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2017-02-16 |