| NPI | 1689730350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX K3679) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX K3679) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2025-09-11 |