| NPI | 1588754873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 13423) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G75477) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO 47769) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV 13342) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2017-02-17 |