| NPI | 1215266580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT020474) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 031259-1) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2024-08-07 |