| NPI | 1063459766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301086651) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 190532) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2008-12-05 |