| NPI | 1982858379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 50298) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7148391-1205) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 7148391-8905) | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2011-12-28 |