| NPI | 1821300492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 74102) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2014 - 01069) |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2016-02-03 |