| NPI | 1477944627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: FL 20-4308734) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |