| NPI | 1336302074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0116020703) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS14764) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.010812) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-07-21 |