| NPI | 1760589378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 178766-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 1787661205) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2013-12-09 |