| NPI | 1881633147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 16342) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 16,342) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2017-03-05 |