| NPI | 1841305257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WV 25999) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 36772) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX P6304) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME107968) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: OR MD160013) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2014-12-07 |