NPI | 1003053653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD-38604) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036148998) |
208100000X Physical Medicine & Rehabilitation (Licence: NY 249874) | |
207R00000X Internal Medicine (Licence: IA MD38604) | |
208100000X Physical Medicine & Rehabilitation (Licence: TX V6499) | |
Enumeration Date | 2009-01-17 |
Last Update Date | 2025-08-08 |