| NPI | 1376511048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD063687L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD063687L) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-07-15 |