| NPI | 1104932508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 172301) |
| Additional Taxonomies | 2278P3800X Respiratory Therapist, Certified, Palliative/Hospice (Licence: NY 172301) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2025-12-03 |