| NPI | 1972560449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G83706) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0428328) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2006028600) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2007-12-10 |