| NPI | 1689787368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 000314) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 183476-1) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 34 . 005275) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-01-14 |