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 | 2025-08-05 |