| NPI | 1326350877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 269202) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 38950) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2022-07-21 |