| NPI | 1881156545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD481133) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: PA MD481133) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2023-07-14 |