| NPI | 1811928013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204R00000X Electrodiagnostic Medicine (Licence: AR E0060) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR E-0060) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AR E0060) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2013-02-14 |