| NPI | 1700100351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 84406) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 83340) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2019-11-15 |