| NPI | 1528225083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME136556) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 248678) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2019-11-19 |