| NPI | 1942484688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS14694) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10050541) |
| 208D00000X General Practice (Licence: PA OT012076) | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2018-04-30 |