| NPI | 1649352543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301059318) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301059318) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2017-05-26 |