| NPI | 1699825505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P6912) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: NY 173976) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-12-04 |