| NPI | 1801918685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD433494) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT186025) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2013-10-25 |