| NPI | 1811980675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 023053) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AR E1524) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-06-28 |