| NPI | 1558383893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL os17915) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OK 3729) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2022-12-29 |