| NPI | 1003053653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA 38604) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 249874) |
| Enumeration Date | 2009-01-17 |
| Last Update Date | 2011-11-07 |