| NPI | 1548521495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AK 1598) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA GFE24362) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WA MD 00010386) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |