| NPI | 1659590735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 37998) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 37062) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2024-08-16 |