| NPI | 1265454664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD436939) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200600824) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-01-12 |