| NPI | 1144480302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX n2707) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 247471) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2020-11-20 |