| NPI | 1477521532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000019569) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TN MD0000019569) |
| 204R00000X Electrodiagnostic Medicine (Licence: MS 13290) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-12-06 |