| NPI | 1083750913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 163969) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 163969) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-03-07 |