| NPI | 1316938236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME124682) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 14560) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-02-07 |