| NPI | 1689776205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: LA 020915) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101051340) |
| 208D00000X General Practice (Licence: VA 0101051340) | |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2012-02-06 |