| NPI | 1184683633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 237464-1) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 237646) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2023-06-01 |