| NPI | 1013956507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD424830) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD424830) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2017-11-01 |