| NPI | 1083357180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 326703) |
| Additional Taxonomies | 208VP0000X (Licence: NY 326703) |
| Enumeration Date | 2022-04-16 |
| Last Update Date | 2026-10-03 |