| NPI | 1396188439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 05-40190) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020027116) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-07-21 |