| NPI | 1689647687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AR C7245) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR C7245) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2009-09-02 |