| NPI | 1851433460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 020442) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 020442) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-09-09 |