| NPI | 1740357722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 016810) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: LA 016810) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-11-13 |