| NPI | 1043221328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200700719) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD428809) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-11-02 |