| NPI | 1396893251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: HI DOS1796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A6517) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-11-07 |