| NPI | 1144455510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME112409) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125056250) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX p5291) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2018-06-29 |