| NPI | 1518928977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101042684) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0042666) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2013-09-19 |