| 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 |