| NPI | 1316979750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 032217) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 032217) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-02-18 |