| NPI | 1639175763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD07222) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: RI MD7222) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2013-09-19 |