| NPI | 1982824090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200400357) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NC 200400357) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2021-04-08 |