| NPI | 1417041526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AK 103783) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 51455) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-06-07 |