| NPI | 1740798701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 6444) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PTA22803) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-03-17 |