| NPI | 1356862205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: NY 041554) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 041554-01) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-07-27 |