| NPI | 1396999652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 55978-21) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 715941-1204) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2015-03-24 |