| NPI | 1669819132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS018668) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO3154) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 279179) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2018-10-08 |