| NPI | 1902326960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0068170) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 34.014927) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101023462) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-11-14 |