| NPI | 1508966441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD13225) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME 013225) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2013-01-11 |