| NPI | 1538237391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 29032) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 17821) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000025621) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-05-14 |