| NPI | 1609082395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 12408) |
| Additional Taxonomies | 2081H0002X (Licence: FL ME74476) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2019-10-31 |