| NPI | 1669609160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 7249) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 244801) |
| 208D00000X General Practice (Licence: ME 2200) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2021-06-30 |