| NPI | 1588669360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0059310) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS5890) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2023-01-09 |