NPI | 1225490410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA11846900) |
Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NY 304958) |
Enumeration Date | 2016-03-25 |
Last Update Date | 2023-12-29 |