| NPI | 1194000745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: FL ma64616) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2011-10-14 |