NPI | 1134623408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 337671) |
Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: NY 337671) |
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 337671) | |
Enumeration Date | 2018-03-21 |
Last Update Date | 2025-09-17 |