| NPI | 1871599944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX J4620) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J4620) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-02-14 |