| NPI | 1043242670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A90461) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 224452-1) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-03-31 |