| NPI | 1225532732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 318664) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 72336) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-11-19 |