| NPI | 1497212971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351048799) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21247) |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2021-06-03 |