| NPI | 1992268205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2024-01381) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0070766) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-06-07 |