| NPI | 1396829529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 117727) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P3626) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2018-04-11 |