| NPI | 1801968961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 071327) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 46888) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 49353) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-03-07 |