| NPI | 1841440823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD438873) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 250299-1) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2016-03-22 |