| NPI | 1447272174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME94791) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME94791) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-07-17 |