| NPI | 1659548857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 48704) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 6851422-1205) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2023-11-27 |