| NPI | 1780616326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 23036) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 130391) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-11-19 |