| NPI | 1447631684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H97600) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.013937) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA OP61113387) | |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2023-08-30 |