| NPI | 1346287828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 16224) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301083153) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-05-10 |