| NPI | 1073501557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 284545) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 225006) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2018-04-27 |