| NPI | 1982669610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N9177) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 229685) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2021-08-17 |