| NPI | 1780115568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 04943) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R4413) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-06-14 |