| NPI | 1922004746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD057871L) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: PA MD057871L) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2022-12-05 |