| NPI | 1750692562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID O-0794) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ID O-0794) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2011012585) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-05-19 |