| NPI | 1366489635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301045353) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 4301045363) |
| 208VP0000X (Licence: MI 4301045353) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-08-05 |