| 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 |