| NPI | 1255518403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D72757) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 07607) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2022-06-28 |