| NPI | 1962647743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 051098) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 261336) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2019-02-04 |