| NPI | 1558672337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NH 17796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 245126) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102203330) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0116023544) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MA 245126) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2018-09-20 |