| NPI | 1881766285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 15,562) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 238,357) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |