| NPI | 1710983283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0715002791) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101032689) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2008-07-18 |