| NPI | 1952506396 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D71073)  | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD 22027)  | 
| Enumeration Date | 2007-06-16 | 
| Last Update Date | 2011-01-08 |