| NPI | 1538175708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A042794) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 108777) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-01-21 |