| NPI | 1649303934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME71587) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: FL ME0071587) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-11-05 |