| NPI | 1740693704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101259131) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO dr.0069769) |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2023-11-08 |