| NPI | 1881894285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102208177) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60662777) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MT 51060) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08261500) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2023-10-31 |