| NPI | 1588614093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N7670) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: IN 02003003A) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2016-10-11 |