| NPI | 1639144918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 11724) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11724) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-06-03 |