| NPI | 1205993409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 040335) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 221024) |
| 174400000X Specialist (Licence: CT 040335) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2015-09-03 |