| NPI | 1508829391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101262365) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 11455) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2018-06-12 |