| NPI | 1750549424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 007204) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WY 11025A) |
| 174400000X Specialist (Licence: SL0518) | |
| 193200000X Multi-Specialty (Licence: HI DO-1245) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2023-04-14 |