| NPI | 1366872749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0040143) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR D020363) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2013-11-20 |