| NPI | 1528389012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 326111) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD449718) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-07-05 |