| NPI | 1104932508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 172301) |
| Additional Taxonomies | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: FL ME143760) |
| 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: NY 172301) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME143760) | |
| 204R00000X Electrodiagnostic Medicine (Licence: NY 172301) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2026-01-28 |