| NPI | 1336534668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A168814) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA10641100) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 298443) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2020-08-18 |