| NPI | 1013538453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 335082) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD484533) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-10-22 |