| NPI | 1518908581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-6825) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 55495) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-09-17 |