| NPI | 1811035025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4539) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A9010) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-08-23 |