| NPI | 1619111564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A123020) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 000) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2022-02-11 |