| NPI | 1053750299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 321443) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13338) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB09905600) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2023-05-12 |