| NPI | 1215698501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 013082-01) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PTA31465) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO PTA.0015136) | |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2023-01-30 |